A New Technique for Augmentation Rhinoplasty Using Hybrid Autologous Grafts with Septal Extension Grafts in Asian Patients

Overview

Building up the bridge in Asian rhinoplasty is complicated by the limitations of each available material. This technique uses different graft forms for different parts of the nose: a solid boat-shaped rib graft over the bone, diced cartilage wrapped in fascia over the cartilage section, and a septal extension graft for the tip.

Sections of note

• Retrospective review of 28 patients, 19 women and 9 men, mean age 27 years, range 18 to 43, operated December 2007 to December 2016; both primary and revision cases.
• Septal extension grafts provided tip projection.
• A solid boat-shaped costal graft augmented the bony bridge; fascia-wrapped diced cartilage augmented the cartilaginous bridge.
• Anthropometric measurements on facial photographs evaluated outcomes in the 15 primary cases, and showed successful augmentation of all nasal parameters.
• The nasal tip was mobile and comfortable in all patients.
• Satisfaction: 12 (42.9%) very satisfied, 10 (35.7%) satisfied, 6 (21.4%) unsatisfied and requiring revision surgery.
• No immediate postoperative complications; 10 (35.7%) had graft-related complications including visibility or warping of the solid graft, supratip depression, and downward deviation of the septal extension graft, none described as serious.

What it means for a patient

• Different parts of the nose received different graft forms, matched to what each area needs.
• More than 1 in 5 patients were dissatisfied enough to need a second operation, and over a third had some graft-related problem.
• All material came from the patient's own body, avoiding synthetic implant risks.
• Limits: 28 patients, retrospective, single surgeon, no comparison group, and objective measurement applied only to the 15 primary cases.

Why this paper matters

Reporting a 21.4 percent revision rate and a 35.7 percent complication rate is unusually candid for a technique paper. It shows autologous dorsal augmentation is not complication-free even in experienced hands. Whether the hybrid approach performs better than a single graft type is not tested.

Terms

• Augmentation rhinoplasty: Surgery adding height or volume to the nose.
• Autologous graft: Tissue taken from the patient's own body.
• Costal cartilage: Rib cartilage, used as a graft source.
• Septal extension graft: A cartilage piece attached to the septum and projecting forward to set tip position.
• Warping: Bending of a solid carved cartilage graft after implantation.